The testicles sit inside the scrotum. They are very sensitive. Even a minor injury can cause pain or discomfort to the testicles. Sudden, severe testicle pain, however, requires immediate medical care.

If a young man has abdominal pain, the scrotum should always be carefully examined. Abdominal pain may occur before testicle pain in some conditions, including testicular torsion. This is a twisting of the testicles that can cut off the blood supply and cause tissue to die. Testicular torsion is an emergency that needs to be treated within hours.

Testicular cancer is usually painless. But any testicle lump should be evaluated by your doctor, whether or not there is pain.

Common causes of testicle pain include:

• Injury
• Infection or inflammation
• Testicular torsion -- most common in young men between 10 and 20 years old

Possible infections include:

• Epididymitis -- inflammation of the ducts through which sperm leaves the testicle. This is often caused by bacteria like chlamydia, a sexually transmitted disease.
• Orchitis -- inflammation of one or both testicles, which may be caused by bacteria or a virus like mumps. Orchitis can occur at the same time as epididymitis or prostatitis (inflammation of the prostate gland).

Fluid in the testicles often causes painless swelling, but may cause mild discomfort. There are several main types of fluid collection:

• Varicocele -- enlarged veins in the scrotum that carry blood away from the testicles.
• Spermatocele -- fluid in the epididymis that forms a cyst and often contains dead sperm cells.
• Hydrocele -- fluid in the area inside the scrotum, surrounding the testicle; common in newborns.

Pain may also be caused by a hernia or an unrelieved erection.

Some causes of testicle pain, including testicular torsion, can lead to infertility if not treated promptly. Infections also should be examined and treated right away. If the infection is caused by bacteria, your doctor will prescribe an antibiotic.

For non-urgent causes of testicle pain such as minor injuries and fluid collection, the following home care steps may reduce discomfort and swelling. These steps will also help if you have an infection.

• Provide support to the scrotum by wearing an athletic supporter.
• Apply ice to the scrotum.
• Take warm baths if there are signs of inflammation.
• While lying down, place a rolled towel under your scrotum.
• Try over-the-counter pain relievers, like acetaminophen or ibuprofen. DO NOT give aspirin to children.

Call your doctor immediately or go to an emergency room if:

• Your pain is severe or sudden
• You have had an injury or trauma to the scrotum, and you still have pain or swelling after one hour
• Your pain is accompanied by nausea or vomiting

Also call your doctor right away if:

• You feel a lump in the scrotum
• You have a fever
• Your scrotum is warm, tender to the touch, or red
• You have been in contact with someone who has the mumps

Your doctor will perform a physical examination with a focus on the groin, testicles, and abdomen. To help diagnose the cause of the pain, your doctor will ask medical history questions such as:

• How long have you had testicular pain?
• Is the pain in one testicle or both?
• Exactly where does it hurt?
• Did the pain begin suddenly or come on gradually?
• Is the pain constant or intermittent?
• How severe is the pain?
• Is the pain getting worse or better?
• Does the pain extend into your abdomen or back?
• Have you had any recent injuries or infections?
• Have you ever had a sexually transmitted disease?
• What makes the pain worse?
• Does anything help relieve the pain?
• Do you have any other symptoms like swelling, redness, change in the color of your urine, fever, or unintentional weight loss?

The following diagnostic tests may be performed:

• Ultrasound of the testicles
• Urinalysis and urine cultures
• Examination of prostate secretions

Treatment may include:

• Untwisting of the testicle (performed by an experienced doctor)
• Simple surgery to fix testicular torsion (if untwisting is unsuccessful)
• Antibiotics for infections
• Pain medications to relieve discomfort
• Surgical drainage or removal of an abscess (rare)
• Surgery for a varicocele, a hydrocele, or spermatocele, particularly if the varicocele is contributing to infertility

• Prevent injury by wearing an athletic supporter during physical activity, especially contact sports.
• Prevent sexually transmitted diseases by wearing condoms and following other safe sex procedures.
• Perform testicular self-exams monthly if you are at risk of testicular cancer. See testicular self exam.
• Make sure that children have received the MMR vaccine (a combination vaccine for mumps, measles, and rubella).

If you are diagnosed with chlamydia or another STD, all sexual partners should be notified, examined, and treated if infected.

Kodner C. Sexually transmitted infections in men. Prim Care. 2003; 30(1): 173-191.

Dogra V. Acute painful scrotum. Radiol Clin North Am. 2004; 42(2): 349-363.